Rischio assoluto, rischio relativo e terapia ipocolesteromizzante con statine [Absolute risk, relative risk, and lipid lowering therapy with statins]

Absolute cardiovascular risk (the likelihood of coronary death, non fatal myocardial infarction and stroke over the following 10 yrs), absolute risk reduction and its derived parameter Number Needed to Treat (NNT), constitute, along with relative risk evaluation, the main metrics of “risk-oriented” preventive strategies. “Risk-oriented” medicine, in fact, assumes the existence of a positive association between baseline absolute risk and the number of events prevented by an effective therapeutic intervention. According to that paradigm, confirmed by several randomized clinical trials with statins, patients at higher risk are likely to draw more benefit from “aggressive” treatment of circulating LDL cholesterol. Limitation of that strategy is focalization on short-term estimates of risk that may grossly underestimate the impact of therapeutic interventions on risk factors acting over much longer time intervals.